冠心病介入治疗前后不同时段血小板活化的变化  

Changes of platelet activation markers at different periods before and after coronary stent implantation

作　　者：彭俊 

机构地区：[1]广东省湛江市中心人民医院心内科,湛江524000

出　　处：《中国循证心血管医学杂志》2015年第3期381-383,共3页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的：研究冠状动脉粥样硬化性心脏病（冠心病）患者介入治疗前后不同时段血小板活化标志物的变化及其临床意义。方法选择2008年1月1日至2014年5月1日在湛江市中心人民医院心内科接受冠状动脉支架置入术治疗的冠心病患者50例，纳入观察组，男32例，女18例，年龄43~62岁，平均年龄（53.6±2.8）岁。另选同期在我院接受健康体检的50例受试者为对照组。使用FACSCalibur型流式细胞仪检测两组血小板相关指标，包括血小板黏附试验（PadT）、血小板聚集试验（PagT）、平均血小板体积（MPV）、血小板分布宽度（PDW）、血小板数量（PLT）及血小板压积（PCT），手术前后不同时段的血小板活化标志物可溶性P-选择素（CD62P）、纤维蛋白原受体（PAC-1）水平。分析观察组患者术后时间与CD62P及PAC-1的相关性。结果观察组的PadT、PagT、MPV及PDW水平均显著高于对照组，分别为[（47.33±3.22）% vs.（40.69±3.08）%]，[（66.25±4.17）% vs.（57.38±3.89）]，[（11.43±1.16）fL vs.（9.74±1.03）fL]，[（17.08±1.42）%vs.（12.13±0.72）%]，PLT及PCT水平均显著低于对照组[（187.49±23.64）×109/L vs.（224.38±46.33）×109/L]，[（0.16±0.06）%vs.（0.25±0.07）%]，差异均有统计学意义（P均＜0.05）。观察组术后即刻的CD62P及PAC-1水平均分别显著高于术前、术后4 h、8 h、12 h及24 h的水平，差异均有统计学意义（P均＜0.05）。冠状动脉支架置入术后时间与CD62P水平呈显著负相关（r=-0.833，P＜0.01）。结论冠心病患者接受冠状动脉支架置入手术治疗，虽可较好地改善血小板活化标志物水平，但仍需预防血栓产生。Objective To study the changes and clinical significance of platelet activation markers at different periods before and after coronary stent implantation in patients with coronary heart disease （CHD）. Methods CHD patients undergone coronary stent implantation （observation group, n=50, male 32, female 18, aged from 43 to 62 and average age=53.6±2.8） and health controls （control group, n=50） were chosen from Jan. 1, 2008 to May 1, 2014. The indexes related to platelet were detected by using FACSCalibur flow cytometry, including platelet adhesiveness test （PadT）, platelet aggregation test （PagT）, mean platelet volume （MPV）, platelet distribution width （MDW）, platelet count （PLT） and plateletcrit （PCT）, and platelet activation markers including soluble P-selectin （CD62P） and PAC-1 at different time points before and after the operation. The correlation among postoperative time, CD62P and PAC-1 was observed and analyzed. Results The levels of PadT, PagT, MPV and PDW were higher [（47.33±3.22）%vs. （40.69±3.08）%], [（66.25±4.17）%vs. （57.38±3.89）%], [（11.43±1.16） fL vs. （9.74± 1.03） fL] and [（17.08±1.42）%vs. （12.13±0.72）%], and levels of PLT and PCT were lower [（187.49±23.64）×109/L vs. （224.38±46.33）×109/L] and [（0.16±0.06）%vs. （0.25±0.07）%] in observation group than those in control group （all P〈0.05）. The levels of immediate CD62P and immediate PAC-1 were higher than those before and 4 h, 8 h, 12 h and 24 h after the operation in observation group （all P〈0.05）. The postoperative time was negatively correlated to CD62P level （r=-0.833, P〈0.01）. Conclusion The levels of platelet activation markers will be improved in CHD patients undergone coronary stent implantation, but thrombosis should be prevented.

关 键 词：冠心病 冠状动脉支架置入术 血小板活化标志物 变化 意义 

分 类 号：R541.4[医药卫生—心血管疾病]